Proving your Social Security Disability Claim

11/11/2014by Mark Buterbaugh

I am often asked how Social Security Judges evaluate appeals that come before them for decision. The answer to that questions is simple. Social Security formalized a five-step sequential evaluation process to determine if a Claimant should be entitled to Social Security Disability benefits (SDD). In fact, they write their decisions granting or denying benefits utilizing the five step process. So what is this five-step evaluation process for Social Security Disability Claim?

Proving Your Social Security Claim

Step One – Have you been Unable to Work for 12 Months?

This is always an easy step to make, at least in Claimants that come to me. If the applicant has not been out of work for 12 or more months or is not expected to be out for 12 or more months, my intake with the client ends. If you haven’t been out of work or expected to be out of work for 12 or more months, then you are NOT ELIGIBLE for SSD.

When we are talking about out of work, we are talking about social security’s definition of substantial gainful activity. Substantial gainful employment amount for 2014 is earning $1070 per month. In other words, if you are making over $1,070 per month, then you are NOT ELIGIBLE for SSD benefits. If you have not had any substantial gainful employment for 12 or more months, then you move to Step Two.

Step Two – Do you have a Severe Medical Impairment?

The condition you indicate on your application and your medical records and evidence you provide must find your alleged condition(s) to be a ‘severe medically determinable impairment.’ In my practice, this usually is not an issue.

Social security usually does indicate on your denial letter that “although your medical condition is severe . . . ” If your condition was not severe, I would not consider taking your appeal. Medical records, diagnostics reports, and reports for your Doctor would indicate the severity of your condition. In many regards, my clients are told by their doctors to apply for SSD. That’s a pretty good indication that your medical records would point to a severe medical condition. So, if your medical condition is determined to be severe, then move to Step Three.

Step Three – Does the Severity of the Impairment Meet the Listings?

Federal Regulations contains a list of medical conditions within a description of a certain severity of that impairment. For example, an applicant can be awarded benefits for Diabetes. However, just because you have Diabetes does not mean you meet that listing nor does it mean you are eligible for SSD. To meet the listing, you must meet the specific criteria listed for that listing. The criteria are very specific and must be documented throughout the medical records.

If your medical records indicate that you meet a listing, then the sequential process ends and benefits can be awarded. I find most clients do not meet a listing. In fact, several Judges do not want listing arguments, because they believe if the records indicated a listing was met, benefits would never have been denied. If you do not meet a listing, we then go to Step Four.

Step Four – Can you Perform Their Past Relevant Work?

First, what is past relevant work? Past relevant work is work that you have done over the past 15 years. There is also an issue with whether you performed that specific work long enough to be deemed to be past relevant work.

If the work is determined to be past relevant work, then it will be classified as one of the following:

Sedentary work

Light work

Medium work

Heavy work.

These determinations are based on exertion levels of the work. Legal arguments can be made to dispute whether the appropriate work designation is made.. If it is determined that the you can perform your past relevant work then the Judge will deny benefits. Social Security will determine your residual functional capacity (RFC). This is their determination based on your file review and possibly a consultative examination on what specifically they believe you can still do despite your medical conditions. If the Judge finds you can’t perform any past relevant work, then we move on to the final Step Five.

Step Five – Can you Perform Other Work?

This is where most social security disability cases are decided. If you can’t do any past relevant work, then the Judge must decide if you can do any other types of jobs. The examination under this step considers your RFC, your age, your education, and any relevant skills to determine what other types of jobs you may be able to do.

A vocational expert is present in your social security hearing to possibly identify jobs that you may be able to do, within your RFC and restrictions identified by the Judge. If it is determined that you can’t perform any other work, then your will be granted SSD benefits.

Count on Mooney

If you have applied for social security disability benefits and have been denied – count on Mooney. We have represented clients in social security disability cases throughout central Pennsylvania, including:

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